Nav: Home

New guideline recommendations for the treatment of mild-to-moderate ulcerative colitis

January 10, 2019

Bethesda, MD (Jan. 9, 2019) -- Most patients with ulcerative colitis (UC) have mild-to-moderate disease characterized by periods of activity or remission, but practice variations exist in disease management. A new clinical guideline from the American Gastroenterological Association (AGA) published in Gastroenterology, the official journal of AGA, addresses the medical management of these patients, focusing on use of both oral and topical 5-aminosalicylates (5-ASA) medications, rectal corticosteroids and oral budesonide, to promote high-quality care for UC patients.

AGA's new clinical guideline is meant to help with the management of patients with mild-to-moderate UC, but not all patients will effectively respond to the outlined therapies. In those cases, there may be a need to escalate treatment to systemic corticosteroids, immunomodulators and/or biologic therapies for induction and maintenance of remission. However, the use of biologic therapies and/or immunomodulators are not specifically addressed within the guideline.

Mild-to-moderate UC was defined as patients with fewer than four to six bowel movements per day, mild or moderate rectal bleeding, absence of constitutional symptoms, low overall inflammatory burden, and absence of features suggestive of high inflammatory activity. Although disease activity exists on a spectrum, patients in the mild-to-moderate category who have more frequent bowel movements, more prominent rectal bleeding or greater overall inflammatory burden should be considered to have moderate disease.

The guideline recommends the following for the medical management of mild-to-moderate UC:

  1. Use either standard dose mesalamine (2-3 grams/day) or diazo-bonded 5-ASA rather than low dose mesalamine, sulfasalazine or no treatment in patients with extensive mild-moderate UC. (Strong recommendation, moderate quality evidence)

  2. In patients with extensive or left-sided mild-moderate UC, add rectal mesalamine to oral 5-ASA. (Conditional recommendation, moderate quality evidence)

  3. In patients with mild-moderate UC with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA or with moderate disease activity, use high-dose mesalamine (>3 g/d) with rectal mesalamine. (Conditional recommendation, moderate-quality evidence [induction of remission], low-quality evidence [maintenance of remission])

  4. In patients with mild-moderate UC being treated with oral mesalamine, use once-daily dosing rather than multiple times per day dosing. (Conditional recommendation, moderate quality evidence)

  5. In patients with mild-moderate UC, use standard-dose oral mesalamine or diazo-bonded 5-ASA, rather than budesonide MMX or controlled ileal-release budesonide for induction of remission. (Conditional recommendation, low quality of evidence)

  6. In patients with mild-moderate ulcerative proctosigmoiditis or proctitis, use mesalamine enemas (or suppositories) rather than oral mesalamine. (Conditional recommendation, very-low-quality evidence)

  7. In patients with mild-moderate ulcerative proctosigmoiditis who choose rectal therapy over oral therapy, use mesalamine enemas rather than rectal corticosteroids. (Conditional recommendation, moderate-quality evidence)

  8. In patients with mild-moderate ulcerative proctitis who choose rectal therapy over oral therapy, use mesalamine suppositories. (Strong recommendation, moderate-quality evidence)

  9. In patients with mild-moderate ulcerative proctosigmoiditis or proctitis being treated with rectal therapy who are intolerant of or refractory to mesalamine suppositories, use rectal corticosteroid therapy rather than no therapy for induction of remission. (Conditional recommendation, low-quality evidence)

  10. In patients with mild-moderate UC refractory to optimized oral and rectal 5-ASA, regardless of disease extent, add either oral prednisone or budesonide MMX. (Conditional recommendation, low-quality evidence)

  11. In patients with mild-moderate UC , AGA makes no recommendation for use of probiotics. (No recommendation, knowledge gap)

  12. In patients with mild-moderate UC despite 5-ASA therapy, AGA makes no recommendation for use of curcumin. (No recommendation, knowledge gap)

  13. In patients with mild-moderate UC without Clostridium difficile infection, AGA recommends fecal microbiota transplantation be performed only in the context of a clinical trial. (No recommendation for treatment of ulcerative colitis, knowledge gap)


Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is most frequently seen in young adults. It is a chronic illness, of which the severity is classified as mild-to-moderate or moderate-to-severe. Most patients experience mild-to-moderate symptoms, with periods of remission and relapse. About 15 to 30 percent of patients with IBD have a family member with the disease. There is research underway to find out if a certain gene or a group of genes makes a person more likely to have IBD.
-end-
The guideline is accompanied by a technical review: that is a compilation of the clinical evidence based on which these recommendations were framed.

Read the "American Gastroenterological Association Institute Guideline on the Management of Mild-to-Moderate Ulcerative Colitis" to review the complete treatment recommendations.

Resource

Inflammatory bowel disease overview

Reference

Ko, C.W., Singh, S., Feuerstein, J.D., Falck-Ytter, C., Falck-Ytter, Y., Cross, R.K. American Gastroenterological Association Institute Guideline on the Management of Mild-to-Moderate Ulcerative Colitis. Gastroenterology (2019), doi: 10.1053/j.gastro.2018.12.009 https://www.gastrojournal.org/article/S0016-5085(18)35407-6/fulltext?referrer=https%3A%2F%2Ft.co%2FEwZ10Ex1wr

Singh, S., Feuerstein, J.D., Binion, D.G., Tremaine, W.J.. American Gastroenterological Association Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis. Gastroenterology (2019), doi: 10.1053/j.gastro.2018.12.008 https://www.gastrojournal.org/article/S0016-5085(18)35406-4/fulltext

About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. http://www.gastro.org.

About Gastroenterology

Gastroenterology, the official journal of the AGA Institute, is the most prominent scientific journal in the specialty and is in the top 1 percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, Current Awareness in Biological Sciences, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index. For more information, visit http://www.gastrojournal.org.

Like AGA and Gastroenterology on Facebook.

Join AGA on LinkedIn.

Follow us on Twitter @AmerGastroAssn, @AGA_Gastro.

Check out our videos on YouTube.

American Gastroenterological Association

Related Ulcerative Colitis Articles:

Fecal microbiota transplant is safe and effective for patients with ulcerative colitis
A single transplant of microbes contained in the stool of a healthy donor is a safe and effective way to increase diversity of good bacteria in the guts of patients with ulcerative colitis, according to new research from Weill Cornell Medicine and NewYork-Presbyterian.
Yoga helps patients with ulcerative colitis
Patients with ulcerative colitis, a chronic inflammatory bowel disease, often relapse at times of stress.
Crohn's & Colitis Foundation and AGA announce conference partnership
The Crohn's & Colitis Foundation and the American Gastroenterological Association announced today that they are partnering to co-sponsor the first-ever 'Crohn's & Colitis Congress,' which will take place in Las Vegas in January 2018.
Low level vitamin D during remission contributes to relapse in ulcerative colitis patients
A new study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) has found that lower levels of vitamin D in the blood increase the risk of clinical relapse in patients with Ulcerative Colitis (UC), an inflammatory bowel disease that causes long-lasting inflammation and ulcers in the colon.
U-M researchers discover what makes drug for ulcerative colitis tick
For approximately 70 years, physicians have used a medication containing the active agent mesalamine to treat ulcerative colitis, but little was known about how the drug targeted the inflammatory bowel disease.
Protozoan parasite increases risk of colitis, study reveals
Researchers from the University of Toronto have discovered that mice infected with the common gut parasite Tritrichomonas muris are at an increased risk of developing inflammatory colitis.
Iron-deficiency anemia in ulcerative colitis -- many patients don't get testing and treatment
Many patients with ulcerative colitis don't receive recommended testing and treatment for the common problem of iron deficiency anemia, reports a study in the October issue of Inflammatory Bowel Diseases, official journal of the Crohn's & Colitis Foundation of America (CCFA).
Transplanting healthy stool might be an answer to ulcerative colitis
Fecal microbiota transplantation -- a treatment currently used to address recurring Clostridium difficile infection -- is also an effective approach to helping individuals who suffer from ulcerative colitis, according to a study being presented at Digestive Disease Week®.
Study advances understanding of colon cancer and colitis
The transcription factor hepatocyte nuclear factor 4-alpha (HNF4-alpha) plays a key role in colon cancer and colitis.
Study shows ozanimod as effective in treating ulcerative colitis
Researchers at University of California San Diego School of Medicine have shown that ozanimod (RPC1063), a novel drug molecule, is moderately effective in the treatment of ulcerative colitis.

Related Ulcerative Colitis Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Don't Fear Math
Why do many of us hate, even fear math? Why are we convinced we're bad at it? This hour, TED speakers explore the myths we tell ourselves and how changing our approach can unlock the beauty of math. Guests include budgeting specialist Phylecia Jones, mathematician and educator Dan Finkel, math teacher Eddie Woo, educator Masha Gershman, and radio personality and eternal math nerd Adam Spencer.
Now Playing: Science for the People

#517 Life in Plastic, Not Fantastic
Our modern lives run on plastic. It's in the computers and phones we use. It's in our clothing, it wraps our food. It surrounds us every day, and when we throw it out, it's devastating for the environment. This week we air a live show we recorded at the 2019 Advancement of Science meeting in Washington, D.C., where Bethany Brookshire sat down with three plastics researchers - Christina Simkanin, Chelsea Rochman, and Jennifer Provencher - and a live audience to discuss plastics in our oceans. Where they are, where they are going, and what they carry with them. Related links:...